Two weeks ago I worked medical at Badwater. This year’s course had some serious uphills and downhills – but the course was dry. Unless one has feet that sweat heavily, there typically would not be any issues with wet feet.

Yes, this post is going to talk more about maceration. I’ve done a number of posts this year on maceration, but the problem won’t go away, so there must be more to learn.

So here’s how maceration happened in a dry year at Badwater and what you need to learn from it.

It’s very simple – really. Runners pour water over their head to cool themselves. Or well-meaning crews douse their runners with water over their heads, or spray them up and down with some kind of tank sprayer. The water runs down the runner’s clothes and body, down their legs, and ends up in the runner’s shoes. Socks and shoes become saturated.

Wet and macerated feet

Sometimes runners will changes socks and shoes during the run, and this helps for a bit, until more water is poured over the runner’s head and down into his or her shoes.

The water buildup leads to softening of the skin and maceration. In the photo you can see three areas of concern. If you click on the image, you’ll open a much larger copy image where you can see the detail even better.

First, the skin has torn at the base of the fourth toe. There may or may not have been a blister with fluid under the skin on the ball of the foot. My guess is it was not a blister, but simply wet softened skin that was stressed and then tore.

Secondly, notice the fold of skin at the bottom of the baby toe. The toe was probably pinched in the shoe toebox, folding under the fourth toe. This puts pressure on the skin of the baby toe, pushing the skin forward into a fold from the tip of the nail to under the toe. When I see these folds, the skin in usually intact and not torn.

Thirdly, notice the fold of skin going down the center of the ball of the foot. This is the most serious of the three problems. The fold is painful. The skin is not torn, but has pulled up and then folded over on itself.

As the skin goes through the maceration process, it first looks like the skin of a prune – shriveled up. The longer the maceration continues, the more chance for the skin to soften. The foot inside the sock, inside the shoe, can be squeezed and as the runner moves through the foot strike, with his whole body weight carried on his feet, pressure is put on the skin leading to creases in the skin. The creases are most common in a line down the length of the foot rather than across its width. Continuing through the maceration process, the creases of softened skin can lead to the skin lifting up and folding over on itself. In the photo you can see the shadow from the fold – it’s significant and can be quite painful.

In this case, all three problems were caused, by the runner’s admission, his pouring water over his head and allowing it to run down is legs into his socks and shoes.

It seems so beneficial to cool yourself off by pouring water over your head and/or by spraying your body and legs – but there are negative side effects.

The hard part for the runner, besides the pain, is that there is no quick fix to remedy the skin folds. It takes time, sometimes days for the skin to return to its normal state.

In an upcoming post I’ll talk about some products to help protect your skin from wet conditions. For now, avoid pouring water over your head. Protect your feet.

I’ve been on vacation much of the past two weeks and given my time away, have turned to a good friend, Alene Nitzky, an experienced and well qualified ultra runner who wrote an article published at the Coloradoan website. You have heard me go on and on about the importance of god foot care. Here’s another slant, from an ultra runner who has run Badwater and many other ultras.

Alene Nitzky

Runners spend all kinds of money on entry fees, clothing, travel to races, nutritional supplements and race foods. They spend all kinds of time on training, body work, stretching, weight training or cross training.

They worry about their weight, hydration, nutrition, sleep, and preparing for race-day conditions. And most of all, they obsess about finding the right shoe.

But in all this obsession, the two things they forget are the most essential tools they have to carry them from start to finish and go into those expensive running shoes.

Their feet.

Your feet are your base of support. They are the vehicle that carries you forward and through the distance. You can’t run without them. So why do so many runners neglect them?

You can do all the right training and preparation, wear the right shoes and gear, but if your feet fail you, it can ruin months of hard work.

The problem is lack of foot care. Blisters are just a symptom of the problem. Friction and moisture are the two culprits in creating blisters. Improper hydration plays an important role, too.

Blisters are caused by layers of skin and fabric or debris trapped inside the shoe or sock, combined with friction from running motion. Creases in socks, rough edges inside shoes, and dirt contribute to these rough spots. Calluses that are allowed to develop on feet and are not removed can lead to deep, painful blisters. Rough or jagged toenails can catch on socks, causing the fabric to bunch and rub against the toes.

The role of hydration, especially too little sodium relative to fluid intake, also contributes to blistering. Fluid travels out of the blood vessels into the tissues and separates layers of skin, making shoes tight and contributing to more friction. Check your hands while running. If your hands are swollen, your feet are swollen, too. Popular sports drinks often don’t have enough sodium to replace what is lost during long, hot weather events.

Regular pedicures are helpful. If you don’t want nail polish and all the extras, you can do much of it yourself. Softening and removing calluses over time reduces the likelihood of blisters under these trouble spots. Soften rough, dry spots with lotion when you’re not out running. Keep your toenails trimmed and filed. Underneath the ball of the foot, most people don’t realize they have callouses, and these are a common trouble spot.

Moisture is another problem, even in our dry climate. If you are running trails with stream crossings or crossing snow banks at high altitude, you are also at risk for developing blisters. But even without water crossings, your feet sweat, and moisture in socks and shoes can become a problem.

Keeping your feet as dry as possible helps. If you have a dry pair of shoes and socks to change into after the stream crossings are behind you, that will help.

Use a good sock that wicks moisture away. There are many different brands at specialty running stores. Keep your shoes and socks clean. If you’re running a road marathon, don’t race in shoes or socks you wore on trails. The dirt will stay inside and cause friction.

A foot kit should be part of every runner’s supplies. You can learn how to give yourself a pedicure, how to stock a foot kit and tips for avoiding blisters and other foot problems by doing some research.

Band-Aids are fine for knees and hands, or even on feet that aren’t being used, but they are not meant for use on feet while running. They don’t hold up to friction, moisture and shearing. The Band-Aid will soon bunch up and crease, and any dirt in your shoes and socks will stick to them, causing more friction.

Two excellent resources for learning how to take care of your feet are John Vonhof’s book, Fixing Your Feet, 5th Edition, Wilderness Press, 2011, and website fixingyourfeet.com. You can also get a free subscription to his fixing your feet blog with helpful tips.

Over my years of taping feet, I have seen techniques improve to where pre-taping is more helpful then ever before.

Often times, in the middle of a race, one cannot take the time necessary to do a high-quality tape job. Things may be rushed. The runner may be in a huge hurry to make a cut-off. The feet and skin may be wet. Conditions may be less than ideal – lightening, set-up, workable access/angle to the feet, supplies, etc.

Bad Tape Job

However, before a race, a hike, or run, there is more time to do a high quality pre-tape job. It’s also the time to practice your skills and learn how to do a really good tape job. The first photo here shows a pretty poor tape job on toes. In this photo, the tape will probably peel off from sock changes and general wear. If any one of the pieces comes off, the now untapped toe will be subject to the roughness of the tape on the neighboring toe. It looks like Leukotape, which sticks well, but does not conform to the curves of toes and other places on the foot. It is possible to do a great tape job on toes with Leukotape – but it take time and practice. I must admit I like Leukotape for certain conditions and tape jobs.

Bogies taped right foot after 157 miles

A good, high-quality pre-tape job should hold up well, for several days if necessary, and cared for. In this next photo, you can see the right foot of Bogie Dumitrescu after finishing a solo, self-supported crossing of Death Valley followed by up and down to Mt Whitney. You can see how the tape has held for 157 miles in the extremes of Death Valley. It’s hot on the valley floor, but there are two long uphill’s climbs followed by long downhill’s over two passes. An 11-mile trail hike follows that up to and another 11 back down Whitney. The tape job held for 157 miles! In fact it looks perfect.

The tape is Kenesio-Tex on the heels, balls of the feet and big toes. Hypafix tape is used in a figure eight cut to anchor the tape at the forward edge of the ball of the foot, between the toes, and anchored again on top of the foot. This prevents the forward edge of the tape from rolling.

Bogie’s feet after 157 miles!

The next photo shows Bogie’s two feet after the tape was removed. No blisters. One of the reasons the tape held is that Bogie managed his feet well. He kept them as dry as possible. This is important in Death Valley where often Badwater runners get their feet wet when they are sprayed or doused with water in an effort to cool them.

Bogie was fortunate to have his feet taped by Denise Jones, the Badwater Blister Queen. Denise is a master at taping feet and does a precision tape job. This is not a 30-minute tape job. It takes as long as it takes to do it right. Denise and I tape almost identically. If we apply a piece of tape and it looks or feels wrong, we remove it and retape. Our aim is to get the runners on the course and able to finish with good feet.

Danny’s Feet Taped Before Badwater

The point of this blog post is to show a good tape job that can hold up over multiple days. The final photo shows Danny Westergaard’s feet that Denise taped for Badwater three weeks ago. Danny’s feet are taped perfectly. You can see the small strip of Hypafix that Denise wrapped around Danny’s big toes to further secure the tape edges.

I commend Bogie and Danny for their runs. Bogie completed his solo self-supported Badwater crossing the week before the official Badwater ultramarathon. Danny completed his 7th Badwater, went to the summit of Whitney and then reversed direction and went back to the start for his 7th Badwater Double.

And I commend Denise Jones for her care of runner’s feet. She’s a class act. Thanks Denise.

Kinesio, Leukotape and Hypafix tapes, as well as Compound Tincture of Benzoin and other foot care supplies are available at Zombierunner.com.

Disclosure: When you purchase through this link, I make an affiliate small amount of each sale.

Several years ago I met Gregg at Badwater in Death Valley. We were in line to check in at Furnace Creek and I heard the last name. It was the same as an aunt of mine. Turns out we are related.

At Badwater he ran well and finished near the top. Later that year, he and his wife moved to Asia and I had not heard from him – until the other day. He sent an email about running the Spartathlon in Greece. It’s a 246-kilometer (153 mile) race between Athens and Sparta. The Spartathlon aims to trace the footsteps of Pheidippides, an Athenian messenger sent to Sparta in 490 BC to seek help against the Persians in the Battle of Marathon. Here’s his email:

I just finished running Spartathlon. It was nearly as hot as Badwater (100.4), ok maybe not as hot as Badwater, but it was far to hot for this race, considering it is normally 86. The race by the way is fantastic; I would highly recommend that you make a trip out there if you get the chance.

So, I took a photo of my feet after the race and thought you might like the photo, being that you are the foot guy. Might make for a good example. The blister appeared to start from underneath the pad of my foot by my big toe. The pressure built up so much that it formed the blister on top of my foot as well – as you can see from the photo. Pretty cool if you ask me. I probably ran with it for 50 miles, since I didn’t change my shoes and didn’t feel like taking them off. They lanced it when I finished… as I was receiving two bags of IV fluid. Haven’t had any problems with it since, although it has taken a few days for the pressure under my foot to slowly recede.

Spartathlon Feet

As you can see in the photo, there is blood in the blister. Here’s where you have to be careful and take precautions to prevent infection. I don’t encourage people to lance these on their own, but in aid stations with the right equipment and knowledge, it can be done. When I do it, I always give the athlete the warning signs of infection: redness, warm to the touch, pain, fever, pus, and swelling. If you have a blood blister, be careful.

Really though, Gregg’s feet look pretty good for just having run 153 miles. Don’t you agree?

Next week is Badwater. I’ll be there along with Denise Jones, patching feet. I’ve captured the press released from Chris because if utilizes the best of social media and the web to keep followers in touch with the race. After the race, I’ll post pictures. Promise. Here’s the story and links.

Badwater

AdventureCORPS, Inc., an event production firm specializing in ultra-endurance and extreme sports events, will host the 35th Anniversary Badwater Ultramarathon on July 16-18, 2012. Recognized globally as “the world’s toughest foot race,” this legendary event pits approximately 95 of the world’s toughest athletes – runners, triathletes, adventure racers, and mountaineers – against one another and the elements. Covering 135 miles (217km) non-stop from Death Valley to Mt. Whitney, CA in temperatures up to 130F (55c), it is the most demanding and extreme running race offered anywhere on the planet.

The start line is at Badwater, Death Valley, which marks the lowest elevation in North America at 280′ (85m) below sea level. The race finishes at Mt. Whitney Portal at 8360′ (2533m). The Badwater course covers three mountain ranges for a total of 13,000′ (3962m) of cumulative vertical ascent and 4,700′ (1433m) of cumulative descent. Whitney Portal is the trailhead to the Mt. Whitney summit, the highest point in the contiguous United States. Competitors travel through places and landmarks including Mushroom Rock, Furnace Creek, Salt Creek, Devil’s Cornfield, Devil’s Golf Course, Stovepipe Wells, Keeler, and Lone Pine.

A true “challenge of the champions,” the 2012 AdventureCORPS Badwater Ultramarathon features 49 Badwater veterans and 49 rookies: die hard “ultra-runners” of every speed and ability, as well a athletes who have the necessary running credentials, but are primarily known for their exploits as adventure racers, mountaineers, triathletes, or in other extreme pursuits. They represent twenty countries by citizenship or residence: Argentina, Australia, Brazil, China, Costa Rica, Czech Republic, Canada, France, Germany, Iran, Italy, Japan, Mexico, Poland, Serbia, Spain, Sweden, United Kingdom, United Arab Emirates, and United States of America (and nineteen America states).

There are 18 women and 80 men. The youngest runner is 23 (rookie entrant Claire Heid of Tacoma, WA) while the oldest is 70 (Arthur Webb of Santa Rosa, CA, a thirteen-time finisher), with an average age of 45. Full details are available on the race roster.

The men’s course record is held by Valmir Nunez of Brazil with a time of 22:51:29 set in 2007, while the women’s course record of 26:16:12 was set in 2010 by Jamie Donaldson of Littleton, CO. It is expected that the winner of the 2012 AdventureCORPS Badwater Ultramarathon will finish in 22 to 26 hours. The average finishing time is approximately 40 hours, while the overall time limit is 48 hours, as compared to the 60 hour limited used in the races held through 2010. For those who finish in less than forty-eight hours, their reward is the coveted Badwater belt buckle. There is no prize money.

The women’s field, with 18 entrants, includes 11 rookies and 7 veterans. Veteran contenders include the 2011 women’s champion, Sumie Inagaki, 46, of Aichi, Japan and Pam Reed, 51, of Jackson, WY, the 2002 and 2003 overall champion who also won the women’s field in 2005. Every year is a new year at the Badwater Ultramarathon, with rookies and “previously unknown” athletes surprising the contenders with top performances. New stars will shine as the race unfolds in July. RACE MAGAZINEDownload the 2012 edition (44 pages; 3.4MB).

BADWATER ON TWITTERFollow the 2012 Badwater Ultramarathon via Twitter. We will post race updates and observations, photo links, and important news and announcements. NOTE: Please use hashtag #bw135 to join the Twitter conversation! Here’s the current conversation stream.

BADWATER ON FLICKROfficial race photos by the Badwater Race Staff will post to Flickr July 15-18. Race Director Chris Kostman’s race photos will post to Flickr July 15-18 in his photostream.

BADWATER ON INSTAGRAMBadwater Race Director Chris Kostman will be posting photos “live” (whenever a cellular connection is available, which is in Furnace Creek and then the latter 1/3 of the course and the finish line) via his Instagram account. Follow his photo stream on your iPhone or Android with the Instagram app and his stream at “chriskostman.” Photos also automatically post to Chris’ Instagram stream for viewing online.

BADWATER ON YOUTUBEWe will be posting videos from the race on the AdventureCORPS YouTube channel. Most videos will appear on Tuesday and Wednesday, where the internet connection is far superior to that in Death Valley.

Feet are a big part of my life. For the past 15 years, Fixing Your Feet has introduced me to great people. I have enjoyed helping runners at events like Western States; Badwater in Death Valley; Primal Quest in Colorado, California and Washington; Raid the North Extreme in BC Canada; the TransRockies in Colorado; Racing the Planet Atacama in Chile; the Coastal Challenge in Costa Rica; the Avon Walk; the Susan G. Komen 3-Day Breast Cancer Walk; and others. In all these events, I have worked on thousands of feet. In addition, I have responded to an uncounted number of emails from folks asking for foot care advice.

The best part has been the people I have met. Runners, hikers, adventure racers, walkers, and their crews. Athletes walking a fine line between making a cutoff in a race, front runners, back of the pack runners, short and long distance hikers, solo and in groups – all ages. Athletes with a simple blister and others with blisters all over. Athletes in pain, and those wanting to quit.

I can recall many of these people. I remember their stories. Some of you are in my stories. I have learned a lot from each person whose feet I have patched. I don’t pretend to know everything about feet. Together we have learned a lot. I thank each of you for what you have contributed to the Fixing Your Feet story.

I wish all my readers a fun, bright, delicious, warm and cozy, and loving Merry Christmas. I hope you can spend time with family and friends.

I ran Badwater as a rookie in 2008 with two years of crewing and pacing experience and several training runs across the valley. I’d never had foot or stomach problems before, but in the race, I suffered from an array of the usual problems runners have there: blisters, swollen ankles, not peeing enough, vomiting, nothing tasting good, and not getting enough calories.

While working on the medical team at Badwater in 2009 and 2010 and watching runners in some of the hot weather races I’ve run, I noticed the difference between runners who took cool down breaks and those who didn’t. Some dunked themselves in a cooler of ice water; others stopped and sat down in the shade of the van or sat in the air conditioning of the vehicle, while others seemed to reject the idea of stopping at any cost, as if it were a 5K road race.

What I also noticed were the number of runners who came to us in Stovepipe Wells, in various stages of dehydration and heat exhaustion, and the amazing turnaround they’d experience by spending an hour inside the air-conditioned medical room. They’d come in unable to urinate, nauseated or vomiting, unable to keep down any food or fluids. They’d lie there on a cot while their crews watched them anxiously.

We didn’t have to do too much for most of them. They’d cool off, sip fluids, and soon they’d be jumping up to urinate, the nausea was gone, they kept food and fluids down, and were on their way with their relieved crewmembers. Most of the time we wouldn’t see them again until they were at the post-race party being recognized for their finish.

What was happening?

Most of your blood flow goes to your skin and major muscles while you’re running in the heat. That means little blood is available to the GI tract, kidneys, and other organs. Low blood flow can rob these organs of oxygen and nutrient-carrying blood and make it hard to digest food and process fluids. This can lead to the puffy hands, bloating, sloshy stomach, nausea, and vomiting, and blistering, especially if you’re not getting enough sodium.

By taking a break, you allow some of the blood to be returned to the organs that allow your normal functions to resume. The blood flow that was going to your skin to keep you cool can go to the kidneys and GI tract again, so you process the fluids and start urinating again.

Here’s how I avoided a downward spiral?

Hydration and electrolyte replacement

Managing hydration and swelling

I experimented with different products for electrolyte replacement. The one I used in 2008 didn’t have enough sodium for the extreme heat of Badwater. In 2011 I used S caps. I had tried them in the heat and humidity of Florida and South Dakota and they worked. I watched my hands for swelling routinely, made it a habit to look at my hands every time I got a new water bottle. If I was puffy, I had to think about what was happening. Usually it happened in the evening as the temperatures cooled down, when I needed less sodium. Then I’d back off. I also noticed that when my hands were puffy, my feet hurt more because they were swelling too.

Cool down breaks

I thought, it makes a lot more sense to take cool downs BEFORE you get overheated. I began trying this in my training. I’d sit for 10 minutes, put my feet up, put a little ice on my neck and legs, and soon, food started to taste better. When I got up to run again, I felt fresh.

I planned 10 minute cool down breaks every 60 to 90 minutes in the stretch between Furnace Creek and Stovepipe Wells. This year it was a lot cooler than previous years, and I often felt like I didn’t need it, so I’d go 90 minutes, but then I made myself stick to my plan. I used these breaks to my advantage to elevate my feet, check my tape, shoes and socks for moisture, get some calories in, and drink more. I had ice wrapped around me in a towel, on my neck, armpits, and thighs.

When I’d get up I usually needed to urinate. Then I’d get moving and I felt fantastic. I ran a lot more of this stretch than I anticipated, and even got into Stovepipe well ahead of my predicted time. The time I spent cooling down paid off.

Learned to work on my own feet

In 2009 and 2010 I watched Denise and John working on runners’ feet as they came in. Ugly, painful blisters, big chunks of skin peeling off their toes and heels. So many of the runners’ feet looked wet, like they’d been taking a bath.

I got a copy of John’s Fixing Your Feet book as soon as the 5th edition came out. I began doing my own weekly pedicure sessions, soaking my feet, working on reducing the calluses. I practiced the taping techniques John shows and found one that works for me. I built a well-stocked foot and first aid kit so I’d have everything I needed. And I kept my feet dry on the run.

Despite over a dozen “foot checks”, cool down breaks, and a few naps, I still managed to better my time from 2008 by over an hour and a half. I was extra cautious with my feet this time because I knew that in order to turn around and run back to Badwater, I was going to have to have my feet intact. On the way back, I followed the same strategy.

When I arrived at Badwater, after 270 miles, the only blister I had left was the one I had at 80 miles. Other than the general soreness that comes from 5 days of running on asphalt, the blister wasn’t really an issue. I used only two pairs of shoes, one for the race and one for the return trip. I never had to go to a larger size because my feet stayed dry and my feet didn’t swell much.

I thoroughly enjoyed my double and ran comfortably the whole way. When you take care of the basics like feet and hydration, everything else tends to fall into place.

Alene Nitzky, Ph.D., RN lives in Fort Collins, Colorado. She has been running ultramarathons since 1991. Check out her blog Journey to Badwater.

Alene Nitzky is a veteran ultrarunner from Colorado who two weeks ago completed Badwater, and then turned around and made it a “Badwater Double” – going back on the course to the start. She had successfully run Badwater before and spent several years working on the medical team. Her Double this year was a success in many ways. Her stomach held up well and her feet cooperated. Here is a report from Alene’s blog about what worked for her feet.

You have to remember that whatever is going on in your hands is also going on in your feet. Avoiding the swelling that comes with fluid/electrolyte imbalance means your feet are not going to swell causing friction against your shoes, the layers of skin and tissue in your feet are not going to swell and separate, which means you avoid blistering.

My biggest problem in 08 was the blister under my left foot. I had a blister in the same spot but over the past year I read John Vonhof’s book Fixing Your Feet and learned how to tape properly, and how to reduce the callus in my problem areas. In 08 the blister was so deep John was unable to drain it with a scalpel, he taped it the best he could to prevent further blistering, and the blister finally popped from repetitive trauma on it’s own at mile 127, which hurt like hell.

Alene's boot w blister at the base of the big toe

This year, it was easy to access the blister pocket and drain it, which was much less painful and much easier to manage. Other than that blister, I developed only a few small, minor blisters, which I was able to easily drain as soon as they developed, and they never became a repetitive problem. At the end of 270 miles, I only had one blister left, the big one under my foot, which didn’t get any worse after 80 miles.

Keeping your feet dry is another requirement. Checking your feet for moisture is critical. I use Drymax socks exclusively and they do very well, but no sock is blister-proof. There are seams, movement in the shoe, and moisture builds up eventually no matter what sock you wear.

My tape job on Alene's blister

Changing your socks frequently is important, and you have to be very careful not to disturb your tape job. Don’t let your crew mess with the lacing on your shoes or pull your socks and shoes off unless they know exactly how to do it right. The runner is better off doing this is they can.

Speaking of shoes, I run in Brooks Addictions and I used only two pairs of shoes, one during the race and the other on the return. I never needed to change shoes or go to a bigger size because my feet never got very swollen and they stayed dry.

We can learn from Alene did. She gets five starts for a well planned and executed race. She ran a good race and with her insights from running it in 08, and years of working on the medical team, she put what she learned into effect. Her Lessons Learned blog post contains great information on hydration, food choices, stomach, and more. I encourage you to check it out. Congratulations Alene on a successful Double.

If you don’t have a copy of Fixing Your Feet, check it out at ZombieRunner.

Disclosure: I have an affiliate relationship with Zombierunner.com and earn a few pennies when you buy though this link.

One of the runners doing next week’s Badwater 135 Mile Ultramarathon recently emailed Denise Jones with questions about managing his feet at this grueling race. Denise cc’d me with her response. I liked what she wrote and decided to use part of it here because it is important information.

[Denise talking about feet getting wet]. How you avoid getting your feet wet is that you avoid getting water sprayed on your legs. It’s your core that needs the cooling anyway. If you are sprayed on the legs, i.e., quads, you have to have it wiped off, then you wipe sunscreen off too. You can survive quite well without getting sprayed on the legs (honest). And, very importantly, you make mental notes about how your feet are “feeling” and address any hot spots BEFORE they grow!

As well, you make sure your crew knows by giving them strict instructions NOT to get you wet below your waist, and if anyone does (they DIE…just kidding). Really. The water that hits your legs runs down the legs into shoes. Depending on how hot it is, which is not looking very hot this year, the water that is sprayed often evaporates. However, if you get those feet wet, then one of the factors that come into play is blisters, i.e., heat, moisture and friction. You can’t avoid heat and friction, so you try to avoid moisture. The tape, as you know, acts as another layer of skin. But honestly, if you do get wet feet, and they blister, then it the athlete either is sucking it up and running anyway with those blisters, which has been done, or drops, which I doubt is on your agenda. Since you are fast, I imagine you are going to be pushing hard and those front-runners can definitely suck it up. When I see their feet afterward, I remark how much better they would have done if they had not allowed their feet to get wet or if they had figured out what works. Certainly socks, sometimes two layers, if you have trained with them and lube, and or powder can work well. Injinji’s often work with a sock over them, with lube and powder under that. The leg sleeves that have become popular now, which I really like, are a culprit I think because they allow water to drizzle into the shoes and socks. While they prevent sunburn, they do act as a catalyst to carry water that is in excess seeping down the legs onto the feet and shoes. That is DEADLY!

What I find is most important is that you have a Plan A – and then Plan B which comes into play if Plan A doesn’t work. Everyone is an experiment of “one”. About the time I think I have the magic combo figured out, someone proves me wrong. Case in point: KNOW YOUR FEET and what causes you problems and address that with a plan and then a backup plan if that fails. Then maybe you won’t need to use it once you are underway. All bets are off if you are pre-taped and those feet get wet because wet tape is not a good barrier. Duct tape is too hot and does not dissipate heat, though it can withstand moisture, often the feet macerate underneath.

Hopefully you do not have deep callus. That is also a “no-no” in my book in Death Valley because we cannot drain deep blood blisters because the callus can’t be penetrated.

Good advice from Denise – a pro about foot care in the heat. I’ll be back next week with a report from Badwater.

This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.

For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.

At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.

She should have.

After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.

What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.

An enormous blood blister

There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.

We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.

What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.

I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.

It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”